Laparoscopic sleeve gastrectomy: a study of efficiency in treatment of metabolic syndrome components, comorbidities and influence on certain biochemical markers.

Abstract

A b s t r a c tIntroduction: The worldwide outbreak of morbid obesity forced contemporary medicine to adopt a multidisciplinary approach, which led to the description of metabolic syndrome (MS): a disease with self-aggravating components and one of the most important causes of morbidity and mortality. The need for therapeutic methods provoked development of metabolic surgery, which nowadays give possibilities for safe and effective treatment of all MS aspects simultaneously and improves many obesity-related comorbidities. Aim: To assess the laparoscopic sleeve gastrectomy (LSG) procedure's efficiency in resolving MS components, treating comorbidities and to analyze the influence on certain biochemical markers in 1-year follow-up. Material and methods: The retrospective cohort study of 211 patients after an LSG operation relied on statistical analysis of clinical data collected prospectively in follow-up visits. All applicable guidelines and bioethical recommendations were respected in this study. Results: Assessment of bariatric efficiency proved the LSG operation to be effective in inducing significant weight loss and treating obesity. Analysis on the influence on MS components, such as non-insulin dependent diabetes (NIDDM), arterial hypertension (AH) and dyslipidemia, showed substantial improvement in all observed cases of these diseases. In the present study, follow-up also proved a partial remission inducing effect of this bariatric operation in many comorbidities, especially in chronic obstructive pulmonary disease, obstructive sleep apnea, peptic ulcer disease and depression. A desirable reduction in creatinine, C-reactive protein, uric acid, alanine aminotransferase, asparagine aminotransferase, g-glutamyltransferase serum levels has also been observed during the follow-up. Conclusions: The LSG is an effective method of treatment in all areas of metabolic syndrome, provides a significant positive clinical outcome in obesity-related comorbidities and induces desirable changes in inflammatory, kidney and liver related biomarkers.

The Effect of Bariatric Surgery on Weight Loss and Metabolic Changes in Adults with Obesity

“…The results of our own research confirm favorable metabolic changes in the course of bariatric treatment, a significant improvement in glycemia and triglycerides, and a tendency to normalize HDL cholesterol. In the 12 months after surgery, the participants of the follow up reached lower glucose concentrations (89.9 vs. 98.0 mg/dL), similar to how the concentrations of total cholesterol, LDL, and TG behaved, while a lower HDL (42.6 vs. 55.0 mg/dL) was observed compared to that of the patients in the study by Wojciak et al [29]. Our patients reached a significant improvement in the concentration of HDL (61.9 mg/dL) a bit later, more than 12 months after surgery.…”

“…The slightly lower loss of weight and BMI 3, 6, and 12 months after bariatric surgery in our examined group in comparison with the outcomes of other authors, might be result of, firstly, the lower initial BMI of our patient group (X ± SD) = 44.5 ± 6.8 kg/m 2 ; Me = 43.4 kg/m 2 (40.2-46.3) vs. X = 45.91 kg/m 2 (min-max 41.40-50.11) [29] and Me = 51.6 kg/m 2 (35.9-72.0) [30]. Secondly, it might be a result of the fact, that in 21% of our patients, GB surgery was performed.…”

“…The difference in loss of weight depending on the surgery method was statistically insignificant (most probably due to the limitation of size); however, the loss of weight observed after this type of surgery was noticeably lower. In the cited studies [29,30], all the patients underwent SG. From a long-term perspective (>24 months of follow-up), our results did not differ significantly from others.…”

“…The effectiveness of intensive lifestyle modification in the prevention of diabetes persisted for 15 years, but over time it weakened [32]. Definitely improved diabetes control results were obtained after surgical treatment by performing laparoscopic Roux-en-Y gastric bypass (LRYGB), and to a lesser extent when using sleeve gastrectomy [29]. After bariatric treatment, there is a sustained reduction in risk factors for cardiovascular diseases (CVD) [33,34].…”

The impact of the last ten minutes of surgery on hemorrhagic complications after laparoscopic sleeve gastrectomy. Case-control study.

“…It gained popularity amongst surgeons due to simplicity. The long term weight loss and metabolic outcomes of LSG are generally good [3][4][5]. Adverse events include gastric leak, stenosis and postoperative bleeding.…”